Reactions 1495, p39 - 5 Apr 2014

SPrasugrel

Gingival bleeding: case reportA 47-year-old man developed gingival bleeding following

treatment with prasugrel for stent thrombosis prevention.The man, whose history included coronary artery disease

and a cardiac stent placement, underwent dental cleaning. Hepresented with a 20-hour history of gingival bleeding. For ayear and a half, he had been taking prasugrel [dosage and routenot stated] to prevent stent thrombosis. Upon examination, hehad clots in all dental quadrants and blood oozing from themandibular gingiva surrounding his teeth. He had taken hislast dose of prasugrel 16 hours prior to presentation [durationof treatment to reaction onset not clearly stated]. His completeblood count showed that he had an adequate number ofplatelets for haemostasis. However, his haemoglobin,haematocrit and mean corpuscular haemoglobin values werelow.

The man was managed with a direct application of pressurewith gauze. He was also treated with topical thrombin,microfibrillar collagen and tight suturing of the mandibularinterdental papillae. The bleeding subsided gradually, and hewas haemostatic the following day.

Author comment: "[T]he immediate and prolonged natureof the bleeding complication supported Prasugrel-inducedthrombocytopathy as the etiology."Lin L, et al. The impact of Prasugrel, a new anti-platelet agent, on dental care ofpatients. Quintessence International 44: 433-8, No. 5, May 2013 -USA 803101289

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